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Friday, September 04, 2015

Bioethics - Doing more harm than good?

Steven Pinker recently ignited a small firestorm with his piece in the Boston Globe arguing that bioethical issues that slow down research have a massive human cost. "Even a one-year delay in implementing an effective treatment could spell death, suffering, or disability for millions of people." Below are some clips from his piece, and rebuttals to Pinker's points can be found in this Nature article:

Biomedical research, then, promises vast increases in life, health, and flourishing. Just imagine how much happier you would be if a prematurely deceased loved one were alive, or a debilitated one were vigorous — and multiply that good by several billion, in perpetuity. Given this potential bonanza, the primary moral goal for today’s bioethics can be summarized in a single sentence.

Get out of the way.

A truly ethical bioethics should not bog down research in red tape, moratoria, or threats of prosecution based on nebulous but sweeping principles such as “dignity,” “sacredness,” or “social justice.” Nor should it thwart research that has likely benefits now or in the near future by sowing panic about speculative harms in the distant future. These include perverse analogies with nuclear weapons and Nazi atrocities, science-fiction dystopias like “Brave New World’’ and “Gattaca,’’ and freak-show scenarios like armies of cloned Hitlers, people selling their eyeballs on eBay, or warehouses of zombies to supply people with spare organs. Of course, individuals must be protected from identifiable harm, but we already have ample safeguards for the safety and informed consent of patients and research subjects.

Biomedical research in particular is defiantly unpredictable. The silver-bullet cancer cures of yesterday’s newsmagazine covers, like interferon and angiogenesis inhibitors, disappointed the breathless expectations, as have elixirs such as antioxidants, Vioxx, and hormone replacement therapy. Nineteen years after Dolly the sheep was cloned, we are nowhere near seeing parents implanting genes for musical, athletic, or intellectual talent in their unborn children.

In the other direction, treatments that were decried in their time as paving the road to hell, including vaccination, transfusions, anesthesia, artificial insemination, organ transplants, and in-vitro fertilization, have become unexceptional boons to human well-being.

Biomedical advances will always be incremental and hard-won, and foreseeable harms can be dealt with as they arise. The human body is staggeringly complex, vulnerable to entropy, shaped by evolution for youthful vigor at the expense of longevity, and governed by intricate feedback loops which ensure that any intervention will be compensated for by other parts of the system. Biomedical research will always be closer to Sisyphus than a runaway train — and the last thing we need is a lobby of so-called ethicists helping to push the rock down the hill.